[caption id="attachment_61725" align="alignright" width="301"] (clockwise from top left) Gary Maisel, Evan Rayner, Todd Salnas, Walt Mickens[/caption]
Now that Western Health Advantage formally announced its expansion into the North Bay, existing care providers said the arrival of a new health plan is an important step in providing choices for employers and consumers and will help those involved move toward a more integrated model of care.Health Care TrendsSept. 24, 2012Providers anticipate Western Health arrivalSutter Health pursues launch of own HMOHealth care column
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It also caps off years of planning among the region's hospitals and independent physicians, who collectively sought collaborations amid an increasingly competitive, consolidating health care landscape spurred by the federal Patient Protection and Affordable Care Act of 2010.
The expansion for Western Health Advantage, which now will include Marin, Sonoma and Napa counties, is poised to receive state approval soon. The HMO intends to begin enrolling customers this year and offer the plan in January 2013. It could be well-positioned to capture the business of a good deal of the North Bay's smaller employers, according to Gary Maisel, chief executive officer. And that, in turn, could help North Bay providers attract their share of patients with employer-sponsored health plans.
"The small-group market has kind of been our wheelhouse for a long time," Mr. Maisel said.
With the smaller employer groups and an eye on the individual market, Mr. Maisel said Western Health Advantage is seeking to secure a firm spot in the forthcoming California Health Benefits Exchange.
"Our intention is to have all of the counties where we're licensed in the exchange," Mr. Maisel said.
Initially, the exchange will define small employers as those with 50 employees or fewer, but that will eventually expand to employers with 100 or fewer employees. That's a large portion of the employers in Sonoma and Napa counties, Mr. Maisel said.
Western Health Advantage will form its network around the 600-plus-member Meritage Medical Network, based in Novato, where it will also sublease space for a small startup office. The network also includes all the region's nonprofit district hospitals (Marin General, Sonoma Valley, Palm Drive and Healdsburg District) and three St. Joseph Health--affiliated hospitals (Petaluma Valley, Santa Rosa Memorial and Queen of the Valley in Napa).
The initial filing with the Department of Managed Health Care only included Marin and Sonoma counties, but Western Health later amended it to include Napa County.
Walt Mickens, chief executive officer of Queen of the Valley, said the inclusion of Napa is of particular importance, given that some 50,000 residents receive their care in neighboring Solano County, where Kaiser Permanente and Sutter Health have large profiles. Indeed, only two commercial health plans are currently available in Napa County -- Kaiser and Blue Shield.
"I think it's great news for Napa County," Mr. Mickens said. "Our mission is to improve health. Anything that improves access helps us achieve that mission."
Todd Salnas, president of St. Joseph Health in Sonoma County, said the new network will be an important step in providing another form of managed care, and that employers will benefit from the added competition. Additionally, the development will enable all hospitals involved to keep patients out of emergency rooms.